Mareeba Model Shows That Consultation, Cooperation And Flexibility May Keep Rural Maternity Units Operating, Australia
The study is published in the latest edition of the Medical Journal of Australia.
The authors - Dr Samantha Scherman (obstetrician gynaecologist), Jan Smith (clinical nurse consultant), and Megan Davidson (registered midwife) - advise, however, that it should not be assumed that the Mareeba model of care would be effective in other regions.
Mareeba is a country town of 8000 people 64 kilometres south-west of Cairns. In May 2005, the local hospital's maternity service, which handled an average of 196 births per year between 2000 and 2004, was closed due to medical workforce shortages.
Six weeks later, the service re-opened as a midwifery-led model of care for low-risk women, with higher-risk patients being referred to Cairns Base Hospital (CBH).
Under the Mareeba model, all women booked with the local maternity unit have a case conference with a Cairns-based obstetrician on a monthly basis, with outpatient antenatal care and inpatient intrapartum and postpartum care provided by the local midwives on a 24-hour basis.
The Cairns obstetrician oversees all emergency care and pregnancy complications. Medical officers from Mareeba District Hospital (MDH) are available to give basic medical assistance in an emergency, and there are four appropriately qualified GPs in the town who can be called upon when urgent medical intervention - including caesarean section - is required.
Dr Scherman says that the model of care available in Mareeba is fully explained to women when they are booked in.
"In general, women appear to have been supportive of this model of care, with very few deciding to change to a different model after their booking visit," she said.
Of the 203 women who were booked for antenatal care at MDH and gave birth in the first year of operation (June 2005-June 2006) of the new model, 170 were categorised as low risk and suitable to give birth at MDH. Of these, 147 did give birth at MDH, with another 17 transferred to Cairns prior to birth, and six transferred during labour.
Of the 33 women categorised as high risk, 22 gave birth at CBH as planned, seven had elective caesarean sections performed by a GP at MDH, and four presented to MDH in labour and gave birth there with no complications. Of the 158 women who gave birth at MDH, 146 (92 per cent) had normal deliveries.
Dr Scherman says that outcomes for the first year of operation of Mareeba's midwifery-led model of care are consistent with a viable maternity unit, but due consideration must be given to the characteristics of each individual rural institution before such a model is implemented elsewhere.
"Mareeba has a favourable combination of characteristics," she says.
"There is a dedicated and experienced midwifery team, a supportive community, a group of women willing to accept the potential limitations of this model of care, a cooperative Cairns Base Hospital to act as the referral centre, supportive and experienced local GPs, and overarching supervision by a Cairns-based obstetrician.
In an accompanying editorial, the Chairman of the National Association of Specialist Obstetricians and Gynaecologists, Dr Andrew Pesce, says the search for models of maternity care best suited to women in rural areas will continue to challenge health service planners.
Dr Pesce notes that it is estimated that more than 130 Australian rural maternity units have closed since 1995.
"It seems likely that continuing provision of maternity services in rural areas will depend on optimum use of the local workforce and health facility infrastructure," he says.
"Individual regional areas will need to come up with arrangements based on consultation with the local community and health workforce.
"This will require a flexible approach and should recognise that transfer of women may sometimes be required, because of temporary unavailability of a core of necessary staff.
"It is unlikely that a 'one size fits all' approach will deliver solutions to all areas at all times.
"It remains to be seen which elements of the Mareeba model of care are most appropriate to consider replicating elsewhere without compromising safety and quality of maternity care," Dr Pesce says.
The Medical Journal of Australia is a publication of the Australian Medical Association.
Australian Medical Association
Mareeba aratã cã modelul de consultare, cooperare ºi flexibilitatea pot sã rurale, unitãþi de maternitate de operare, Australia - Mareeba Model Shows That Consultation, Cooperation And Flexibility May Keep Rural Maternity Units Operating, Australia - articole medicale engleza - startsanatate